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1 SCHOOL STREET CT - BUILDING INSPECTION .� . , � No. .� �� � � , , . . APpLICATION FOp ' ^ . ' p�HMtl' 'tn • .�� . � ��-��� ��6��. �,- � . . . � a" Z .s' � I l ;;_ -,s LOCATION . ` �-� .,. . . - � . • �• �� �tieo � �� C�'l, " � � � � � � PE MIT GRANT[D _ • �• : � � � Z3 � � t _ . ' . - . APP OV�p - . CTO(j OF BU DINGS ,� - -- : ,� . ._ � _ : CERTIFICATS OF OCCIIPANCY " . YES , ' , . NO �. c .� -7— � : ' = _ . ,^ , - _ _ : • - _ r:. ,. . ' .,_ • , -. . . . : .. t,'. i ' . ' I . � � ; j � ' %! ' i � . . " DATE: ��I D �(�� ' . + - . �� .� �itp Df ��Y�PIl�, �A���L�U�Et�� . � � � ' ,(�r � � �qAIAR �, PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERNIIT BEING GRANTED Location of Building � SC'h00� S�7'2P�" c_!/U/'-T Building Permit Applicati r: '(Circle whichever applies�Reroof, Install Sidin ct Deck, Shed,Pool Addition, Alteratio epair/Replac Foundation Onty, Wrecking Other: �.1 1 PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: ' The undersigned hereby applies for a permit to build according to the foliowing spec�cations: OwuersName: I-�].tY,C!"(� Q, l�ylpy�A� .u/�S{�e(A(`,� Contractor: � �'. � Sr'.i"vIC,eS'�}]Y15 t�rzL Street I S ChOal 5-�Y.ee-1 �DUi'-�- C�«• SL�f e�r� str�c�l�� �J nr�h S�F.� c;ri.�l err, un+t a - . _ State.M A Phone (qq� �H I - ba(o I State M A Phone� �Q�$� 7!�L,-,0�-I o�� �b'�t� CityotSalemLic# IWUS Street Cit}• State Lit ()5� HIp# ����o�9 State Phone ( ) , Homeowners E:empt Form_yes,�no Structure: (ptease circle) Single Famil}•, Multi Fanu� Other Estimated Cost of jab S I 5 yl 7 7, � I � Will buildiog coufirm t law?�yes no , Asbestos?____yes�no • • L Description oi work to be done:_ J`�"1'/� 2 X /5-hil'�Q YDZ�� 1n S fG( �� �7�/��/� q� U ee �u�a �-er �l 3/;) s v�i�ry � of nP�.� 3-�.� � n�i 5l�, mlP`�, �v�5fu N .3'/z s� r i�tr.os ta�' r�6� .r ��o��-�n � rva�' ��+� �titr�-� • �nsfu�� � a La l .���GG,��,���h`� u A&A SERVICES, INC. Drawing ubmitted: ves no Mail Permit to: �SALEM, MA 01970 i �41-042d."-' - I )( � � �VWU��W.A-�AS�ERVAIES.�OM � Siguature of Application,SIGNED UNDER THE PENALTY OF PERJURY � CONSTRUCTION TO BE COMPLETED WITf3IN SIX (�MONT$S OF PERMIT ISSUED DATE �.� The Commonwealth of Massachusetts I j10 Department of Industrial Accidents a. L Office of Investigations �tf tk / {Iji; 600 Washington Street IR Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoalicant Information tt Please Print Legibly Name(Business/Organization/Individual): �_ A Se—r 1/f a S ,Tn Address: IISSire e+ City/State/Zip:-5ALP_IAM13 Of q-70 Phone #: ( q�$1 e NI- H Are�u an employer?Check the appropriate box: J Type of project(required)- ].lVJ I am a employer with�� 4. i am a general contractor and [ employees(full an Pail have hired the sub contractors 6 El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These on have 8. C1 Demolition working forme in any capacity. workers' comp.insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs I required.] t employees. [No workers' comp.insurance required.] L 13.EOther •Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. t Ilomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name orthe sub-contractors and their workers'camp.policy information. lam an employer that is providing workers'compensation insurance for my employees: Below is the pollcy and job site information. -f� Insurance Company Name: t r me— T22 \/O I -er,<) Policy#or Self-ins.Lic. #: \A/0- CJ 3q X I oZ ti l n Expiration Date: I'' Q_7 Job Site Address: S1`I7M/ s7` e �Of jl� City/State/Zip: y(t.IP_/Yl t It/fJ Ol5//1,0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 7rid hereby cernWlainspenalties of perjury that the information provided above is true and correct ature: Phone#: ��"f$) 7/�I - DHa,)-4 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 71nspector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbi 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that."every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confmnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ; Boston, MA 02111 `^ . Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax #617-727-7749 www.mass.gov/dia DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined.by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Cartina - FF Signature of Permit Applicant 9-0 -07 Date Christopher Zorzv Name of Permit Applicant A & A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code T� 1°JanN.eanr�ea�e �✓Gl�A�/ - Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 Birthd`ate[_5/26/1958 Expiration p 5/26/2009 Tr# 13739 Restn�on E CHRISTOPHER Z~ RZY;' 1�� 115 NORTH ST ,�''I --G-- SALEM, MA 01970 Commissioner Commonwealth of Massachusetts Division of Occupational Safety Robert J Prezioso,Commissioner Deleader-Contractor CHRISTOPHER ZORZY EDate 04/02/07 0 " Exp. Date 04/01/08 DC000440 - Memhero/C.O.N.E.S T. j.. 8 BO I VIII VIII VIII VIIIIIIIIIIIII VIIIVIIIIIIIIIIIIIIII BOSTONRENE 71. 1°Jo�nimaxr�ea.CC/e a�./ aaaac/usaella Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 101609 Expiration: _.6/26/2008 Type: Private Corporation -A&A SERVICES, INC' Christopher Zorzy - 115 North Street;, - Sal6m,-MA 01970 Deputy Admmrst lor,'�. . ��% A & A SERVICES, I•NC. MAS gIM 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 ROOFING SPECIFICATION SHEET - - Buyers)Name Date of Contract Buyens)Stree Address,City,State and Zip Code _ Daytime Thephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 7 77-6 The Buyeds)listed above hereby jointly and severely agree to purchase the goods and/or services listed below.In accordance with the prices and terms described on this Specification sheet and the Iron and Me reverse of Me accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which Mia Specification Sheet Is a part ROOFING SPECIFICATION Strip of of# layers of shingles Install 6'of ice and water shield at base of roof where SKInstall 15.1h felt paper tcFroot. Fposs' le. if 6 Flash chjmney as needed(no repointing included). Install V erimeter drip edge to rakes and fascia areas. ienstall vent pipe boots and seal as needed. ❑ Flash valleys as needed ❑ Install rollout type ridge vent. Planks/plywood replacement under 32 SO FT included, 'If more is needed there will be an extra charge of$6-4ow per h r for labor plus the cost of materials. Dumpster/Disposal Included: Other: Gte F17 1'lH.flrt If rR'W A iGY - Location: V ON R'151'd,_- N ©rtL�ON Install new roof: Manufacturer e2 A;nieQ , r� yr Style/type S t Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. 1 RUBBER ROOFING SPECIFICATION �D �iO>7<l234f�9d�dr'�14U 1-1 Z5 5d`S5p Roof ❑Not Strip Roof - - Install 1/2"High Density Fiberboard to existing roof using Wi obstacles as needed. screw nd plates. Install.060 membrane EPDM(Black)rubber roofing to WInstall 3x3 aluminum drip edge to perimeter of roof with fiberb d S seam tape. Flash up sidewall as needed. Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS • E r d a Sip Ge s ale n4q!9 iV9l9/S AD 14Iry ii c�r�I�Ga.�,'vk�#� Lown �$!aT fl1Et� r I r f It is agreed and understood by and between the parties Met this SpecMcaaon Shast,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,committee Ma entire understanding between Me parties,and More are no verbal understandings changing or modifying any of Me users.This contract may net be changed of Its terms modmed or veiled in any way unless such changes au in wdting and signed by bad Me guyems)and the contracto,au arda)hereby acknowledge Mat auyarts) has mad this Specification Sheet Contractor Initials:_ 1 Date: �� Buyer's Initials: Date: /tY 07 Arms A & A SERVICES, INC. . A S &S 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Co tract . GIS rd /� o Buyers)Street Address,City,State and Zip Code s%a �l Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: q (- The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front ang the reverse of this agreement and any specification sheets(this"Agreement,and Buyers)have requested that such goods or services be installed or produced at Buyer's Morass listed above.ABA Services,Inc.("Conbactori hereby agrees to install or cause to be Installed the products or services listed in his Agreement at the Buyer(s)address written above. This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in h the casasst of the goods and ,vices purchased as do b it ful agents of timing or approval of any financing Buyer(s)may seek for their purchase. IAA r Purchase Price: 00 Est.Starting Date: aA Down Payment: – Est.Completion Date: " a Caeh Amount Due on Stan of Job: ❑Check ❑Credit Card Amount due on of Completion: No. Amount Due on ofCompletion: Expiration Date: Balance Due on Upon Completion: CVC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the partles,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyers)hereby acknowledge that euyerial has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,Including the two attached Notice of Cancellation forms,on the date first written above. Buyers)also (1)acknowledge that they were orally Informed of their right to cancel this transaction;and(ii)request that they be contacted via their ° telephone numbers or email,as listed above, in the event Contractor believes Buyer(s)would be Interested in any additional quality products or servioes of Contractor. DO NOT SIGN TBIS CONTRACT IP IT COMAINS ANY BLANK SPACES. A&A Servic� Buyert s) By: �� Signature Signature t Print Name Print Name Signature Print Name You,the Buyer(st,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. 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If you do make me goods wal le to the color and am Saner coca el pack man up ...aO data al.d&e d your Natur al completbn,,may rota.a dlsgwe da aOmdz whin n days of the date of you r Nome d commiAM.you may Nown or dispoa of the pored .am any,..Motion.It you Ml to make Me We evmlede he me All o,n you alow wimimu"ouMar MllgaWn IIyW Islam nuke may ala avalleda bine$eYa,or alyou ape to Mum me title to me seller and of m do as Men you mmab nada M pBrbmune of all ho mum the c Wmme Smb,up fail b der 9a men you rear io Oct.so,performance al at obeigatbm under me consent.To crani his booduccn,mac or canter a ages and deice ropy abll0aeM9wbvlM contra0.To muni road oertsadmn,mol or deMer a hi and bated saw ' of Memntedison mNw o,any come wrawn roam,Or send a Mwmm,reABA of me crcelmtbn maw w env otherwilts.twain,or mM a telapern.b MA servarn.its fordssbms,smem,MasvchumW 01 Ins NOTIpIER TNAN MmNIGXr OF Norm Sbmt,amem,Maea9Cl OM 0191 NOT TATER TXAN 1010i OF (Dads) mart HEREBYru NCELTHISTRANSACTION. Cmsunerl SynBWre Oers IHEREBy CMCELTNISTRANSALTON. ConzumaSSlymemor Due